Global myocardial ischemia as a complication of an acute type A aortic dissection - Rapid diagnosis of a case by transesophageal echocardiography

A 36-year-old female was admitted for severe chest pain followed by profoun d shock. Electrocardiography showed severe ST segment depression (0.5-0.7 m V) in all leads except aVR and aVL. Echocardiography revealed an intimal fl ap in the ascending aorta and coexisting, grade 3 aortic regurgitation. She was immediately intubated and transferred to the intensive care unit. Tran sesophageal echocardiography (TEE) demonstrated an intimal tear at 2 cm abo ve the sinotubular junction, and the ostium of the left main trunk was oppr essed by the intimal flap during diastole. Emergency graft replacement of t he ascending aorta and aortic hemiarch concomitant with aortic valve resusp ension was performed successfully. The ECG changes reversed to normal immed iately after the operation. The patient was extubated 2 days postoperativel y and discharged from the hospital 14 days postoperatively, TEE is useful f or the rapid evaluation of coronary malperfusion as a complication of acute aortic dissection, especially in patients with hemodynamic instability.